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İLERLEYİCİ KERATOKONUSTA HIZLANDIRILMIŞ ( 9 MW/CM²) KOLLAJEN ÇAPRAZ BAĞLAMA TEDAVİSİ: 12 AYLIK TAKİP SONUÇLARI

Yıl 2018, Cilt: 1 Sayı: 1, 15 - 19, 13.08.2018

Öz

Giriş: Bu çalışmada amacımız ilerleyici keratokonuslu olgularda, hızlandırılmış kollajen çapraz bağlanma (KÇB)
tedavisinin görme keskinliği ve topografik parametreler üzerindeki sonuçlarını incelemektir.
Yöntem: İlerleyici keratokonus tanılı 29 hastanın 29 gözüne epiteli kazındıktan ve riboflavin damlatıldıktan sonra
hızlandırılış KÇB (10 dakika boyunca 9 mW/cm² Ultraviyole A (UV-A) ) tedavisi uygulanmıştır. Ameliyat öncesi ve ameliyat sonrası 12. ayın sonunda Sirius cihazı kullanılarak elde edilen kornea topografisi değerleri istatistiksel olarak
karşılaştırıldı.
Bulgular: Ameliyat sonrası 12. ayda düzeltilmemiş görme keskinliği (DGK) ile en iyi düzeltilmiş görme keskinliği
(EİDGK) tüm hastalarda ameliyat öncesi değerlere göre istatistiksel olarak anlamlı derecede iyileşme gösterdi (hepsi
için p< 0,05). Düz keratometri (K1) değeri anlamlı olarak değişmez iken, dik keratometri (K2), ortalama keratometri
(Kort) ve maksimum keratometri (Kmax) değerleri istatistiksel olarak anlamlı derecede düşük bulundu (hepsi için p<
0,05). Korelasyon analizinde ameliyat öncesi ve sonrası 12.ayda Kmax değişim değeri ile ameliyat öncesi DGK, EİDGK
ve Kmax değerleri arasında pozitif korelasyon olduğu görüldü (r = 0,409, p = 0,027; r = 0,744, p <0,001; r = 0,955, p
<0,001).
Tartışma: İlerleyici keratokonus hastalarında 10 dakikalık 9 mW/cm² hızlandırılmış KÇB tedavisi 1 yıllık takip sonunda görme keskinliğinde artış ve keratometrik değerlerde iyileşme sağlayarak hastalığın ilerlemesini durdurmada
etkili bulunmuştur.

Kaynakça

  • 1. Galvis V, Sherwin T, Tello A, Merayo J, Barrera R, Acera A. Keratoconus: an inflammatory disorder? Eye. Jul 2015;29(7):843-859.
  • 2. Wheeler J, Hauser MA, Afshari NA, Allingham RR, Liu Y. The Genetics of Keratoconus: A Review. Reproductive system & sexual disorders : current research. Jun 3 2012(Suppl 6).
  • 3. Ruckhofer J, Stoiber J, Alzner E, Grabner G. [Intrastromal corneal ring segments (ICRS, KeraVision Ring, Intacs): clinical outcome after 2 years]. Klinische Monatsblatter fur Augenheilkunde. Mar 2000;216(3):133-142.
  • 4. Twa MD, Karpecki PM, King BJ, Linn SH, Durrie DS, Schanzlin DJ. One-year results from the phase III investigation of the KeraVision Intacs. Journal of the American Optometric Association. Aug 1999;70(8):515-524.
  • 5. Grabner G, Ruckhofer J, Tratter C, Alzner E. [The intrastromal corneal ring (KeraVision Ring, ICR, ICRS). A modern method for correcting minor myopia]. Wiener medizinische Wochenschrift. 1997;147(12-13):309-321.
  • 6. Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Current opinion in ophthalmology. Aug 2006;17(4):356-360.
  • 7. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. American journal of ophthalmology. May 2003;135(5):620-627.
  • 8. Hammer A, Richoz O, Arba Mosquera S, Tabibian D, Hoogewoud F, Hafezi F. Corneal biomechanical properties at different corneal cross-linking (CXL) irradiances. Investigative ophthalmology & visual science. May 2 2014;55(5):2881-2884.
  • 9. Strmenova E, Vlkova E, Michalcova L, et al. [The effectiveness of corneal cross-linking in stopping the progression of keratoconus]. Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti. Dec 2014;70(6):218-222.
  • 10. Kymionis GD, Grentzelos MA, Liakopoulos DA, et al. Long-term follow-up of corneal collagen cross-linking for keratoconus--the Cretan study. Cornea. Oct 2014;33(10):1071-1079.
  • 11. Brittingham S, Tappeiner C, Frueh BE. Corneal cross-linking in keratoconus using the standard and rapid treatment protocol: differences in demarcation line and 12-month outcomes. Investigative ophthalmology & visual science. Dec 2 2014;55(12):8371-8376.
  • 12. Zotta PG, Moschou KA, Diakonis VF, et al. Corneal collagen cross-linking for progressive keratoconus in pediatric patients: a feasibility study. Journal of refractive surgery. Nov 2012;28(11):793-799.
  • 13. Tomita M, Mita M, Huseynova T. Accelerated versus conventional corneal collagen crosslinking. Journal of cataract and refractive surgery. Jun 2014;40(6):1013-1020.
  • 14. Cinar Y, Cingu AK, Turkcu FM, et al. Accelerated corneal collagen cross-linking for progressive keratoconus. Cutaneous and ocular toxicology. Jun 2014;33(2):168-171.
  • 15. Ozgurhan EB, Kara N, Cankaya KI, Kurt T, Demirok A. Accelerated corneal cross-linking in pediatric patients with keratoconus: 24-month outcomes. Journal of refractive surgery. Dec 2014;30(12):843-849.
  • 16. Alnawaiseh M, Rosentreter A, Bohm MR, Eveslage M, Eter N, Zumhagen L. Accelerated (18 mW/cm(2)) Corneal Collagen Cross-Linking for Progressive Keratoconus. Cornea. Nov 2015;34(11):1427-1431.
  • 17. Hashemi H, Miraftab M, Seyedian MA, et al. Long-term Results of an Accelerated Corneal Cross-linking Protocol (18 mW/cm2) for the Treatment of Progressive Keratoconus. American journal of ophthalmology. Dec 2015;160(6):1164-1170 e1161.
  • 18. Waszczykowska A, Jurowski P. Two-year accelerated corneal cross-linking outcome in patients with progressive keratoconus. BioMed research international. 2015;2015:325157.
  • 19. Choi M, Kim J, Kim EK, Seo KY, Kim TI. Comparison of the Conventional Dresden Protocol and Accelerated Protocol With Higher Ultraviolet Intensity in Corneal Collagen Cross-Linking for Keratoconus. Cornea. May 2017;36(5):523-529.
  • 20. Elbaz U, Shen C, Lichtinger A, et al. Accelerated (9-mW/cm2) corneal collagen crosslinking for keratoconus-A 1-year follow-up. Cornea. Aug 2014;33(8):769-773.
  • 21. Epstein RL, Chiu YL, Epstein GL. Pentacam HR criteria for curvature change in keratoconus and postoperative LASIK ectasia. Journal of refractive surgery. Dec 2012;28(12):890-894.

ACCELERATED (9 MW/CM2) CORNEAL COLLAGEN CROSSLİNKİNG FOR PROGRESSİVE KERATOCONUS-A 1-YEAR FOLLOW-UP

Yıl 2018, Cilt: 1 Sayı: 1, 15 - 19, 13.08.2018

Öz

Introduction: In this study, we aimed to investigate the effects of accelerated collagen cross-linking treatment on
visual acuity and topographic parameters in progressive keratoconus cases.
Method: Twenty-nine eyes of 29 patients with progressive keratoconus were treated with accelarated epi-off CXL
(9 mW / cm² Ultraviolet (UV-A) treatment for 10 minutes). After one-year follow up data obtained by Sirius topography
system were compared with the baseline topographic parameters.
Results: Uncorrected visual acuity (BCVA) and best corrected visual acuity (BCVA) improved statistically significantly in all patients at 12 months postoperatively (p<0,05 for all). Steep keratometry (K2), mean keratometry (Kort),
and maximum keratometry (Kmax) values were found to be statistically significantly lower (p <0.05 for all), however
Flat keratometry (K1) was not differed significantly. Correlation analysis revealed a positive correlation between preoperative and postoperative Kmax change values, preoperative BCVA, BCVA and Kmax values (r = 0,409, p = 0,027, r =
0,744, p <0,001, r = 0,955, p <0,001 ).
Discussion: The 10 minute 9-mW / cm² accelerated collagen cross-linking treatment in progressive keratoconus
patients was found to be effective in increasing visual acuity and improving keratometric values and prevent disease
progression after 1 year of follow-up. 

Kaynakça

  • 1. Galvis V, Sherwin T, Tello A, Merayo J, Barrera R, Acera A. Keratoconus: an inflammatory disorder? Eye. Jul 2015;29(7):843-859.
  • 2. Wheeler J, Hauser MA, Afshari NA, Allingham RR, Liu Y. The Genetics of Keratoconus: A Review. Reproductive system & sexual disorders : current research. Jun 3 2012(Suppl 6).
  • 3. Ruckhofer J, Stoiber J, Alzner E, Grabner G. [Intrastromal corneal ring segments (ICRS, KeraVision Ring, Intacs): clinical outcome after 2 years]. Klinische Monatsblatter fur Augenheilkunde. Mar 2000;216(3):133-142.
  • 4. Twa MD, Karpecki PM, King BJ, Linn SH, Durrie DS, Schanzlin DJ. One-year results from the phase III investigation of the KeraVision Intacs. Journal of the American Optometric Association. Aug 1999;70(8):515-524.
  • 5. Grabner G, Ruckhofer J, Tratter C, Alzner E. [The intrastromal corneal ring (KeraVision Ring, ICR, ICRS). A modern method for correcting minor myopia]. Wiener medizinische Wochenschrift. 1997;147(12-13):309-321.
  • 6. Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Current opinion in ophthalmology. Aug 2006;17(4):356-360.
  • 7. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. American journal of ophthalmology. May 2003;135(5):620-627.
  • 8. Hammer A, Richoz O, Arba Mosquera S, Tabibian D, Hoogewoud F, Hafezi F. Corneal biomechanical properties at different corneal cross-linking (CXL) irradiances. Investigative ophthalmology & visual science. May 2 2014;55(5):2881-2884.
  • 9. Strmenova E, Vlkova E, Michalcova L, et al. [The effectiveness of corneal cross-linking in stopping the progression of keratoconus]. Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti. Dec 2014;70(6):218-222.
  • 10. Kymionis GD, Grentzelos MA, Liakopoulos DA, et al. Long-term follow-up of corneal collagen cross-linking for keratoconus--the Cretan study. Cornea. Oct 2014;33(10):1071-1079.
  • 11. Brittingham S, Tappeiner C, Frueh BE. Corneal cross-linking in keratoconus using the standard and rapid treatment protocol: differences in demarcation line and 12-month outcomes. Investigative ophthalmology & visual science. Dec 2 2014;55(12):8371-8376.
  • 12. Zotta PG, Moschou KA, Diakonis VF, et al. Corneal collagen cross-linking for progressive keratoconus in pediatric patients: a feasibility study. Journal of refractive surgery. Nov 2012;28(11):793-799.
  • 13. Tomita M, Mita M, Huseynova T. Accelerated versus conventional corneal collagen crosslinking. Journal of cataract and refractive surgery. Jun 2014;40(6):1013-1020.
  • 14. Cinar Y, Cingu AK, Turkcu FM, et al. Accelerated corneal collagen cross-linking for progressive keratoconus. Cutaneous and ocular toxicology. Jun 2014;33(2):168-171.
  • 15. Ozgurhan EB, Kara N, Cankaya KI, Kurt T, Demirok A. Accelerated corneal cross-linking in pediatric patients with keratoconus: 24-month outcomes. Journal of refractive surgery. Dec 2014;30(12):843-849.
  • 16. Alnawaiseh M, Rosentreter A, Bohm MR, Eveslage M, Eter N, Zumhagen L. Accelerated (18 mW/cm(2)) Corneal Collagen Cross-Linking for Progressive Keratoconus. Cornea. Nov 2015;34(11):1427-1431.
  • 17. Hashemi H, Miraftab M, Seyedian MA, et al. Long-term Results of an Accelerated Corneal Cross-linking Protocol (18 mW/cm2) for the Treatment of Progressive Keratoconus. American journal of ophthalmology. Dec 2015;160(6):1164-1170 e1161.
  • 18. Waszczykowska A, Jurowski P. Two-year accelerated corneal cross-linking outcome in patients with progressive keratoconus. BioMed research international. 2015;2015:325157.
  • 19. Choi M, Kim J, Kim EK, Seo KY, Kim TI. Comparison of the Conventional Dresden Protocol and Accelerated Protocol With Higher Ultraviolet Intensity in Corneal Collagen Cross-Linking for Keratoconus. Cornea. May 2017;36(5):523-529.
  • 20. Elbaz U, Shen C, Lichtinger A, et al. Accelerated (9-mW/cm2) corneal collagen crosslinking for keratoconus-A 1-year follow-up. Cornea. Aug 2014;33(8):769-773.
  • 21. Epstein RL, Chiu YL, Epstein GL. Pentacam HR criteria for curvature change in keratoconus and postoperative LASIK ectasia. Journal of refractive surgery. Dec 2012;28(12):890-894.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Mustafa Eliaçık

Ahmet Kırgız Bu kişi benim

Yayımlanma Tarihi 13 Ağustos 2018
Gönderilme Tarihi 7 Temmuz 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Eliaçık M, Kırgız A. İLERLEYİCİ KERATOKONUSTA HIZLANDIRILMIŞ ( 9 MW/CM²) KOLLAJEN ÇAPRAZ BAĞLAMA TEDAVİSİ: 12 AYLIK TAKİP SONUÇLARI. MRR. 2018;1(1):15-9.